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III Causal Factors

5. What is the patient's own analysis of the cause or causes of his drinking? What are his reasons for relapses or for the continuance of drinking periods?

6. Is he nervously unstable? What evidence does he give of such nervous instability? Has this condition developed recently or has it been present since childhood? Is there reason to suspect that he is mentally deficient? (See questionnaire regarding a Child Possibly Feeble-minded, p. 441.)

7. Are the home conditions such as to incline him to seek the saloon as more cheerful? Is the home situated in the vicinity of saloons? Is it squalid and in disorder? Does he take his meals at home? If so, are they well cooked?

8. Has he been unfortunate in business or family affairs? Has he suffered from any painful disease or been in ill health? Has he suffered any severe shock or loss which unsettled him and caused him to turn to drink? Is he happily married? Is his wife of a nagging disposition, or has she any bad habits that make trouble between them? Has he children, and if so are they of good health and habits? 9. Is his employment such as to expose him unduly to the temptation to drink (brewery worker, teamster, hack-driver, bartender, butler, waiter, longshoreman, etc.)? Does he work long hours in extremes of temperature? Under trying conditions of dust, humidity, or bad ventilation? Does he get drunk only when unemployed?

10. (For a woman) Has she been in the habit of using alcoholic liquors every month when unwell? Has she had frequent pregnancies? Has she used alcohol to give her an increased supply of milk for nursing?

IV Drinking Habits

11. Does the patient have something to drink every day or every week? Are there periods of weeks or months during which he will not touch alcohol, which alternate with periods of complete intoxication?

12. Does he do most of his drinking in the saloon? In the home? With other members of the family? Does he take alcohol in the morning before taking food? Is he a solitary drinker; that is, does he drink only when off by himself? If in the saloon, does he buy his drinks or is he treated?

13. Has he any drug habit in addition to his alcoholism? Was the alcohol habit acquired as a substitute for any drug habit? Have drugs been used to promote or encourage "sobering up" from drinking?

14. Does he desire to be rid of his alcohol habit? Is he indifferent about it? Is his attitude antagonistic on this subject? If the first, is his desire due to a mental antagonism to his habit, of which he is ashamed, or is it dependent upon the need of treatment for some physical disease which may or may not be due directly to alcoholic poisoning?

V Physical Condition and Medical Treatment

15. Has he ever been under medical treatment for the alcohol habit? If so, what was the nature of the treatment? Was he treated at a hospital? How long?

Did he leave on the advice and with the consent of the physician? Did he cooperate after leaving in any medical after-care? Did he undergo treatment at home?

16. With regard to the present, has patient lost weight? larly and is his appetite good? Does he sleep well? firmity?

Does he crave food regu-
Has he any physical in-

17. Has he been examined recently by a physician? If so, what was his report? 18. If no physician has been consulted about patient's habit, are not medical advice and treatment needed either before or at the same time that social treatment begins? Is it possible to secure these from a physician who is especially interested in the diagnosis and treatment of inebriety on both the physical and the mental side? Does this physician advise a general medical examination also?

VI Social Conditions

19. Patient's exact statement in detail as to feeling of inefficiency due to alcohol? Has the drink habit led to loss of work? Has unemployment from this cause been occasional? Frequent? Habitual? Time lost from work during last year? Financial loss to patient and family during this period? During his last three drinking bouts?

20. Is the patient and are his family reduced to poverty because of his drink habit? 21. Does his wife have to work to help support the family? Are the children obliged to work also?

22. If his work is steady, is he paid off regularly on Saturday? Does he, as a rule, turn over part of his wages to his wife or family? If so, what proportion of his wages?

23. Does he obtain money from his wife or children to buy drink? Does he ever pawn household articles with this object in view?

24. Does he abuse other members of the family when drunk? When sober? 25. Is there any evidence that he has criminal tendencies? Do these criminal tendencies antedate his drunkenness or do they occur only during the periods of intoxication?

VII Social Treatment

26. Has there ever been an attempt, apparently successful, to make the patient a total abstainer, and under what circumstances?

27. Has he ever been arrested for drunkenness?* If so, was he fined?* Imprisoned?* Released on probation?* Has he been repeatedly arrested for this offense? Was he ever sent to a hospital for treatment as a condition of probation or suspended sentence?*

28. Can any new adjustment be made in the home which will help him to recovery? What will win the co-operation of his family and make his surroundings more livable?

29. Is complete change of environment desirable and possible, either as a temporary measure for a period of special treatment or permanently? Has he formed harmful associations with which his connection should be broken? Are there helpful associations which could be formed-as with a church or settlement club or with an individual volunteer? Could anyone formerly a drunkard but now an abstainer be brought to take an active personal interest in him?

30. Has he, or has he ever had, any religious affiliations? Has he shown himself susceptible to religious influences? Has he had contact with churches, missions, etc.? What is his attitude toward religion?

T

CHAPTER XXVII

THE INSANE-THE FEEBLE-MINDED

HESE two disabilities, of insanity and of feeble-mindedness,

It

carry us still farther than that of inebriety into the territory where medical and social data are not easily separated. cannot be too emphatically stated, however, that the questionnaires here given can in no sense enable a social worker to make a medical diagnosis; the diagnosis of mental disease and of mental defect must be regarded always as primarily medical, though social data of the right kind can suggest the need of a physician in the first place and may be serviceable to him later in making an inclusive examination of his patient.

Insanity is a term describing a legal rather than a medical concept. It is loosely applied to mental disorders differing widely in their origins and in their manifestations. Obviously no one questionnaire would be equally applicable to persons suffering from senile mental reduction, those exhibiting undue pressure of mental and physical activity, and those in whom slow distortions of mental life are taking place. From the alienist's point of view, the present outline merely suggests general lines of inquiry; for the social worker, however, its questions are not routine questions and must not be so understood.

The social worker without medical training is sometimes ill fitted to face the ugly facts of defect and disease. To keep his sense of values keen and true, his must be a spirit of sane helpfulness. No one has described the right attitude better than Dr. Adolf Meyer, who, five years ago, sent the writer the following comments, among others, in criticising a discouraging record of social work with a family of defective mentality.

We meet here a very difficult problem. As far as I can see, the social worker like the physician must learn to accept human nature and human doings as they are before rushing in with the superior knowledge of how they ought to be. The first need is to know what they are. . . The motto of every social worker and in

vestigator must be that of Terence's Heauton Timorumenos: Homo sum, bumani nihil a me alienum puto. . . . One who investigates must be ready to accept anything human beings think, feel, or do as not altogether strange in human nature: "I am but human and I do not consider anything human foreign to me"; it is at least worthy of human consideration.

He was convinced that there was no way of stating the facts effectively "except by stating them directly and concisely in terms of actions and perhaps also in terms of motives and prevailing desires and tendencies taken from the person's point of view rather than from that of the critic or helper." Such general terms in the record submitted to him as "incorrigible," "immoral," "serious trouble," "not very well," "troublesome"-all containing a judgment-were unfortunate, in his opinion, because they did not give the facts which would have enabled anyone else to judge for himself.

The questionnaire given later in this chapter on the Child Possibly Feeble-minded (the possibly defective adult must be understood to be included in this title) was prepared by Mrs. Hilbert F. Day. Mrs. Day also made the first draft of the questionnaire here given on the Patient Possibly Insane. This has been revised and added to by Dr. Thomas W. Salmon, Medical Director of the National Committee for Mental Hygiene, to whom the writer is also indebted for the following suggestions to be observed in using it: Great stress must be laid upon changes in mood, mental processes, activities, and social reactions. It must be remembered too that the apparent mental status of the patient varies, in its external manifestations, at different times of the same day-for example, the nocturnal restlessness and cloudiness of toxic and of senile cases. Special effort should be made to ascertain whether abnormal manifestations are increasing or diminishing in number and in intensity, as this often has a practical bearing upon the management of the case. It might be suggested, as a good general guide, that weight be given to the apparent reasonableness of all activities. There could be unfavorable answers to many of the following questions when the social worker's client was a normal subject; nevertheless, the reasonableness of this or that activity or this or that reaction under the circumstances which actually existed is the significant point.

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